Large language models (LLMs) such as ChatGPT, Claude, Llama, and Qwen are emerging as transformative technologies for the diagnosis and treatment of various diseases. With their exceptional long-context reasoning capabilities, LLMs are proficient in clinically relevant tasks, particularly in medical text analysis and interactive dialogue. They can enhance diagnostic accuracy by processing vast amounts of patient data and medical literature and have demonstrated their utility in diagnosing common diseases and facilitating the identification of rare diseases by recognizing subtle patterns in symptoms and test results. Building on their image-recognition abilities, multimodal LLMs (MLLMs) show promising potential for diagnosis based on radiography, chest computed tomography (CT), electrocardiography (ECG), and common pathological images. These models can also assist in treatment planning by suggesting evidence-based interventions and improving clinical decision support systems through integrated analysis of patient records. Despite these promising developments, significant challenges persist regarding the use of LLMs in medicine, including concerns regarding algorithmic bias, the potential for hallucinations, and the need for rigorous clinical validation. Ethical considerations also underscore the importance of maintaining the function of supervision in clinical practice. This paper highlights the rapid advancements in research on the diagnostic and therapeutic applications of LLMs across different medical disciplines and emphasizes the importance of policymaking, ethical supervision, and multidisciplinary collaboration in promoting more effective and safer clinical applications of LLMs. Future directions include the integration of proprietary clinical knowledge, the investigation of open-source and customized models, and the evaluation of real-time effects in clinical diagnosis and treatment practices.
Humans ; Large Language Models ; Tomography, X-Ray Computed

Objective:To retrieve and summarize the evidence for postoperative observation time and bed rest time in patients undergoing percutaneous renal biopsy, so as to provide evidence-based basis for postoperative nursing of patients undergoing percutaneous renal biopsy.Methods:Using search terms such as "renal biopsy" and "renal puncture", based on the "6S" evidence resource pyramid model, evidence on postoperative observation time and bed rest time of percutaneous renal biopsy patients, including guidelines, best practice information books, evidence summaries, systematic reviews, expert consensus, and original research, was systematically searched on various guideline websites, evidence-based databases, original research databases, and professional association websites both domestically and internationally. The search period was from database establishment to July 1, 2023. After independent evaluation of the included literature by two researchers, evidence was extracted and summarized from the literature that met the quality standards.Results:A total of nine articles were included, including one guideline, five cohort studies, and three cross-sectional studies. This study summarized six best pieces of evidence from two aspects, namely postoperative observation time and postoperative bed rest time. For patients with low risk of complications after percutaneous renal biopsy, it was recommended to observe for 6 to 8 hours after surgery, but further shortening the observation time to 4 to 5 hours may also be safe and sufficient. For patients with high risk of complications after percutaneous renal biopsy, those living far from the hospital, those living alone, or those who may experience significant psychological stress after biopsy, it was recommended to extend the observation time to up to 24 hours.Conclusions:Based on existing evidence, it seems feasible to shorten the bed rest time after percutaneous renal biopsy. A large amount of high-quality research is still needed to explore the optimal postoperative bed rest time.

Objective:To explore influencing factors of the self-reported brief life quality satisfaction score(Brief-QoL) in patients with acromegaly and understand the persistent low Brief-QoL scores in cases achieving biochemical remission.Methods:This study included 836 acromegaly patients who were hospitalized at Peking Union Medical College Hospital between January 2012 and December 2020. We retrospectively examined how clinical characteristics, biochemical parameters, comorbidities, and symptoms influenced Brief-QoL. Among patients who achieved biochemical remission, differences in clinical symptoms and comorbidities were analyzed between the high and low quality of life groups.Results:Patients with well-controlled biochemical indicators at the last follow-up had generally high Brief-QoL. However, patients with symptoms such as headaches (47.8% in the low-score group vs 14.9% in the high-score group, P<0.001) and joint pain (69.6% in the low-score group vs 19.0% in the high-score group, P<0.001) had low Brief-QoL despite biochemical remission. Receiving combined treatment(52.4% in the low-score group vs 27.5% in the high-score group, P=0.030) and having comorbid diabetes or hyperlipidemia were significant factors leading to decreased quality of life. Conclusion:Brief-QoL is suitable for follow-up of outpatient patients. Early identification of factors affecting quality of life and timely intervention can facilitate the realization of standardized management.

The global trends of nontuberculous mycobacteria (NTM) infection and disease are both rising. Nontuberculous mycobacterial disease(NTMD) is a worldwide health burden associated with increasing morbidity, mortality, and economic costs. Antibiotic therapy is the mainstay of treatment for NTMD.Mycobacterial pathogens are intrinsically resistant to many available antibiotics, making treatment extremely challenging, especially in immunocompromised individuals and patients with underlying chronic lung conditions. Even with lengthy therapy and the use of a combination of antibiotics, only less than half NTMD patients can achieve clinical treatment success, so it is urgent to develop novel anti-NTM antibiotics. This article reviews the research progress on the medication of nontuberculous mycobacterial diseases.

Cow′s milk protein allergy (CMPA) is one of the most common presentations of food allergy seen in early childhood.It is an abnormal immune response caused by cow′s milk protein.CMPA can be clinically subdivided into either immediate-onset IgE mediated or delayed onset non-IgE mediated, or both.At present, concerns regarding the early and timely diagnosis of CMPA have been high-lighted over the years and there are many expert consensus on CMPA in China, but these consensus did not distinguish IgE mediated or non-IgE mediated CMPA.In view of the obvious clinical differences between the two type of CMPA and non-IgE mediated CMPA is more common in infancy, experts focus on pediatric gastroenterology, allergy/immunology, dermatology, nutrition and child healthcare convened by the Allergy Prevention and Control Professional Committee of Chinese Preventive Medicine Association present this guideline to help practitioners in primary care settings to early recognize and make suitable management of non-IgE mediated CMPA in China.The guideline incorporates the cutting-edge international guidance and the actual situation of Chinese children describing in detail the types, clinical features, diagnosis and nutritional intervention of non-IgE mediated CMPA.There are 42 recommendations in 7 categories in total referring to the common questions related to non-IgE mediated CMPA.

The aim of the present study is to explore the association between abdominal obesity and chronic kidney disease (CKD) through a systematic review of published studies. Databases including Wanfang data, CNKI, VIP, CBM, Cochrane Library, PubMed, Web of science and Embase were searched up to July 2021 to collect longitudinal studies published in Chinese and English on the association between abdominal obesity and CKD. In order to avoid omission, reference lists of related articles were also checked manually. After literature selection, data were extracted and study quality was evaluated by the Newcastle-Ottawa scale. Statistical analysis of this study was conducted using Stata 11.0 software. Finally, five studies were included in this study. The results showed that abdominal obesity defined by waist circumference was not associated with CKD (OR=1.17,95% CI:0.93-1.48). According to the results of subgroup analyses, whether adjusted body mass index might be part of the reason of heterogeneity. Based on results of this study, the association between abdominal obesity defined by waist hip ratio and CKD, as well as the association between abdominal obesity and CKD in different genders, remains unknown. In conclusion, abdominal obesity might not be associated with incident CKD. However, more studies are needed in the future to explore this association.

Currently, tuberculosis, including both pulmonary tuberculosis (PTB) and extra pulmonary tuberculosis (EPTB) still widely spread worldwide. EPTB has become one of research hotspots, changes in the incidence of EPTB and its composition in TB have occurred, the situation varied with country and region. The age and gender distributions of EPTB cases were different, even contradicted, indicated by different studies. The incidence rate and prevalence rate of EPTB might be underestimated due to insufficient attention paid to EPTB, inadequate diagnostic methods and low diagnosis rate. The cure rate of EPTB is always lower than PTB, posing challenges to global TB control. This paper summarizes the progress in research of EPTB epidemiology in recent years in terms of EPTB definition, epidemiological characteristics of EPTB in the world, correlation of different EPTB and related risk factors to provide reference for the prevention and control of EPTB.

Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis. The high incidence rate, drug resistance rate and mortality rate of TB infection cause serious social and economic burden in developing countries. Due to high occupational exposure, medical institutions and healthcare workers take the potential risk of TB infection, which have negative impact on the public health and occupational health. As one of the countries with high burden of TB in the world, the occupational exposure of healthcare workers in China is serious, and the infection rate is far higher than that of developed countries. This article reviews the prevalence of latent tuberculosis infection among health care workers and the status quo of occupational protection in medical institutions in China.

Objective:To explore the value of tumor diameter to preoperative carcinoembryonic antigen (CEA) ratio (TCR) in predicting prognosis of patients with non-metastatic colorectal cancer.Methods:The clinical data of 144 patients with colorectal cancer in Hainan Hospital of PLA General Hospital between July 2012 and December 2017 were retrospectively analyzed. Patients were divided into the low TCR group and the high TCR group according to the optimal value of TCR in predicting the disease-free survival (DFS) determined by the receiver operating characteristic curve (ROC). The clinicopathological features of both groups were analyzed, and the influencing factors of DFS were also analyzed by using Cox proportional hazard model.Results:ROC analysis showed that TCR had a certain value in predicting DFS, and area under the curve (AUC) was 0.614 (95% CI 0.507-0.722); when the value of TCR was set at 0.690, the sensitivity and specificity of predicting the 3-year DFS rate was 46.3% and 70.9%, respectively. According to 0.690 of TCR, there were 50 cases in the low TCR (< 0.690) group and 94 cases in the high TCR (≥0.690) group. There were no statistically significant differences in the high and low TCR between the two groups for patients stratified by gender, age, tumor location, differentiation degree, invasive depth, lymph node metastasis, TNM stage (all P > 0.05). Univariate analysis showed that TCR, preoperative CEA level and TNM stage played a role in predicting DFS of patients (all P < 0.05), while Cox multivariate analysis indicated that TCR < 0.690 ( HR = 2.369, 95% CI 1.279-4.388, P = 0.006) and Ⅲ stage in TNM stage ( HR = 2.214, 95% CI 1.346-3.640, P = 0.002) were the independent risk factors of influencing DFS (all P < 0.01). The 3-year DFS rate of patients in the low TCR group was lower than that of those in the high TCR group (62.0% vs. 83.0%, P = 0.007). Conclusion:TCR could have a certain value in judging the prognosis of non-metastatic colorectal cancer patients, and low TCR patients have a poorer prognosis.

Objective The cyst excision is considered as priority management of the female paraurethral cyst.The purpose of this present study was to explore the feasibility and safety of the two-step excision with treatment for the female paraurethral cyst.Methods Twenty eight consecutive women with paraurethral cyst underwent paraurethral cyst removal were enrolled retrospectively in this study from October 1,2005 to August 12,2008 in Urology Department of West China Hospital.Results All cases were followedup from 6 months to 2 years,no recurrence occurred.No complications such as urethral stricture and urethralvaginal fistula were found.Conclusions The 2-step excision is the reference technique for cure of female paraurethral cyst.Urethra injury was avoided efficiently,because anatomical relationship between cyst and urethra could be clearer when the technique of 2-step excision was applied.